| NPI | 1154773380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 1013194) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT210975) |
| 208600000X Surgery (Licence: RI MD17987) | |
| 208600000X Surgery (Licence: GA 112785) | |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2026-05-05 |